Surgical clip applier

ABSTRACT

A surgical clip applier comprising a housing, a pair of handles pivotally connected to opposite sides of the housing, and a jaw blade assembly fixedly connected to the housing. The jaw blade assembly includes a pair of jaws for receiving and deforming a clip therebetween and a clip carrier for supplying a series of clips to the jaws. A channel assembly is slidably mounted with respect to the housing and envelops the jaw blade assembly for camming the jaws closed upon closing of the handles. The clips may be fed to the jaws by a spring biased feed bar which operates upon closing of the handles, or may be urged by pusher bar which provides a biasing force to the clips to be retained by the jaws. The instrument may be used in conventional surgical procedures, or may be adapted for endoscopic and laparoscopic surgical procedures requiting the application of microsurgical clips.

CROSS-REFERENCE TO RELATED APPLICATIONS

This is a continuation of appln. Ser. No. 08/311,049 filed on Sep. 23,1994, now abandoned which is a continuation-in-part of appln. Ser. No.08/134,017, filed Oct. 8, 1993, now abandoned which is acontinuation-in-part of appln. Ser. No. 07/959,201, filed on Oct. 9,1992 now abandoned.

BACKGROUND OF THE INVENTION

1. Field of the Invention

This application relates to an instrument for applying to surgical clipto body tissue, and more particularly to instruments for applying asurgical clip for anastomoses of a blood vessel in conventional surgicalprocedures and endoscopic or laparoscopic surgical procedures.

2. Discussion of the Prior Art

The term "anastomosis" covers a variety of procedures in which bloodvessels such as veins and arteries, or other tubular members, such asparts of the colon, intestines, stomach, etc., are joined orreconnected. These vessels may be joined in a variety of relativeorientations, including end-to-end and end-to-side. Solid tubularstructures such as peripheral nerves can also be joined together, aswell as sold structures such as subcutaneous tissue and skin.

The recent advances made in the field of microsurgery has led to thedevelopment of alternatives to conventional suturing processes ofjoining vessels in order to accommodate the minute size of the vessels,nerves and tissues being joined during microsurgical procedures. Thesealternatives have also been developed with an eye towards preventingthrombosis which tends to occur at the points of penetration of theneedle and sutures. An alternative to suturing is the use of surgicalclips which are applied along the vessel juncture to perform a holdingfunction similar to that of sutures, but without penetrating the vesselwalls. Two such non-penetrating clips are shown in U.S. Pat. Nos.4,586,503 and 4,733,664 to Kirsch et al. The former patent discloses asurgical microclip formed of plastically deformable metal or plasticmaterial having minimal spring-back when crimped. The clip has a pair ofparallel curved legs joined by a bridge at one end and terminating inrounded tips at the other end. The clip grips the edges of adjacent andeverted tissue by crimping the legs together. The latter patentdiscloses a vascular surgical clip comprising a plastically deformablebody portion, a tang for deforming the body, and a neck connecting thetang to the body, wherein the neck is designed to break upon applicationof a predetermined excessive tensile force to the tang, and the body isdesigned to deform upon application to the tang of less than thepredetermined tensile force.

As described in the above patents, the non-penetrating clips are appliedover opposed edges of the vessels, the edges first being everted, orturned outward, to form flanges that are gripped between the jaws of theclips. Eversion not only enables the clip jaws to better grip thevessels, but also insures that only the interior surfaces of the vesselsare in contact.

Vascular microsurgical clips are typically applied with a smallhand-held tool that enables the surgeon to precisely place the clip overthe tissue edges, and then to close the clip, as by applying a squeezingpressure to the tool. One example of a prior art clip applier for use invascular microsurgery is disclosed in both U.S. Pat. Nos. 4,733,664 and4,929,240 to Kirsch et al. These patents disclose a tool for applying asurgical clip, the tool including means for gripping and applyingtension to the tang of the clip while also having means forsimultaneously pushing against shoulders on the clip body. The tooldisclosed in these patents requires that a clip be reloaded into theclip applier after each clip is fired, which is disadvantageous in thatthe vessels being repaired need to be returned to their intendedfunction as quickly as possible, particularly blood vessels.Furthermore, the devices disclosed in these patents and in the prior artgenerally require relatively large incisions for the surgeon to accessthe vessel to be repaired.

The development of laparoscopic and endoscopic surgical procedures andthe success of these procedures has led to the need for microsurgicaltools such as vascular clip appliers which can be utilized withoutrequiring large incisions. Vascular clip appliers which apply microclipsby accessing the surgical site through trocar cannulas would greatlybenefit the patient through significantly reduced recovery time.

The need therefore exists for an instrument for applying such a surgicalclip which can be utilized for vascular anastomosis, particularly duringendoscopic and laparoscopic surgical procedures. One specific need isfor an instrument that can hold a plurality of clips and automaticallyfeed and apply the clips individually to the vessel. It would also bedesirable for the instrument to include an elongated body portion whichmay be placed down a trocar cannula to access the surgical site in anendoscopic or laparoscopic surgical procedure. The instrument needs tobe simple to manufacture, easy to manipulate and which applies the clipswith consistent accuracy so as to provide a secure joining of vesselsand tissue. Since the instrument is intended to apply clips duringvascular anastomosis it would be desirable to configure it similarly toother vascular surgical devices, i.e. tweezers or pincer-likeimplements, which are held between the thumb and forefinger of the user.

SUMMARY OF THE INVENTION

The present application discloses an instrument for applying a surgicalclip to a blood vessel during a microsurgical anastomosis procedure. Theclip applier is designed for storage of multiple clips, and individual,automatic feed of the clips into the jaws of the instrument. Further,the applier is designed to be similar in design to other instrumentsused during vascular surgical procedures, i.e. to be like a tweezer orother pincer-like implement at the handle end, while also including anendoscopic portion to enable the instrument to be placed through atrocar cannula to access an internal surgical site during an endoscopicor laparoscopic surgical procedure.

The present device provides a surgical clip applier which is constructedwith a pair of jaws for receiving and deforming a clip therebetween, aclip holding means having a series of clips for delivery to the jaws, afeed bar having a nose at a distal end and means for sequentially movingthe feed bar from an initial distal-most position with the nose behind aclip positioned between the jaws to a proximal-most position behind aforemost clip of the clip series. A pusher bar moves the series of clipsdistally. Alternately, the series of clips may be arranged for asequential feed to the jaws under spring biasing, so that the feed barmay be eliminated.

The means for sequentially moving the feed bar includes a pair ofhandles which are connected to the feed bar and which are movablebetween an open position corresponding to the distal-most position ofthe nose and a closed position corresponding to the proximal-mostposition of the nose. The handles also effect the closing of the jaws tocrimp the clip positioned in the jaws, by advancing a channel assemblyduring closing of the handles which cams the jaws shut. The handles areoppositely and pivotally connected at the proximal end of the housingand are actuated at their distal ends, thereby improving the tactilityand visibility of the working end of applier, as well as the stabilityof the instrument.

The jaws are part of a jaw blade assembly which is fixedly connected tothe housing. The channel assembly is slidably mounted with respect tothe housing to envelop the jaw blade assembly with the feed bar slidablymounted in the channel assembly in overlying relation to the clipholding means. A spring is provided in the housing for biasing the feedbar in a distal direction and for biasing the channel assembly in aproximal direction such that the handles are also biased into an openedposition. A clip retainer is provided to prevent movement of the clipsby holding the clips against movement of a pusher bar which moves theseries of clips positioned on the clip holding means, until the feed barmoves proximally and biases the clip retainer away from the series ofclips so that the pusher bar may move the series distally as the feedbar slides the next clip between the jaws.

In operation, the applier initially has a clip positioned between thejaws. Thus, a surgeon places the jaws of the applier about the evertedend of the vessels and then squeezes the handles together. In responseto closing of the handles the channel assembly is moved in a distaldirection thereby closing the jaws to crimp the clip. At the same time,the feed bar is moved in a proximal direction to a position behind theforemost clip in the clip holding means. Once the handles are released,the jaws open to release the crimped clip, and the feed bar moves in thedistal direction to push the foremost clip in the series to a positionbetween the jaws. The applier is then ready for application of the nextclip.

In another embodiment, the clip applier includes a rotation knob forrotating the channel, jaw blade assembly, clip cover and a feedmechanism which is independent of the handle. This clip applier alsoincludes a window for viewing a clip indicator which displaysapproximately how many clips remain in the device. Further, the tip ofthe jaws are angled approximately 30 degrees for better visibilityduring application of the clip. In this embodiment, a spring biasedpusher bar is located behind the series of clips and urges the seriesforward in the distal direction towards the jaws. The jaws include araised stop portion having an arcuate clip receiving groove whicharrests forward or distal movement of the clips and accurately positionsthe next clip in the jaws for crimping. After the handles are closed tocrimp the clip in the jaws, and then are opened to release the crimpedclip, the pusher bar urges the series distally to place the next clip inbetween the jaws.

In yet another embodiment, the clip applier includes an elongatedportion for insertion through a trocar to perform endoscopic andlaparoscopic procedures. A seal may also be provided to preventinadvertent leakage of the insufflation gas utilized in such procedures.The seal may comprise an O-ring or similar type seal to prevent leakagethrough the instrument itself. The instrument permits the application ofmicroclips in endoscopic procedures to repair vessels without largeincisions.

BRIEF DESCRIPTION OF THE DRAWINGS

The present application will be more fully appreciated as the samebecomes better understood from the following detailed description of thepresent invention when considered in connection with the followingdrawings in which:

FIG. 1 illustrates a perspective view of a first embodiment of theinstrument;

FIG. 2 illustrates an exploded perspective view of the instrument;

FIG. 3 illustrates a top view of the handle of the instrument takenalong lines 3--3 of FIG. 1;

FIG. 4 shows a bottom view in partial cross-section of the distalportion of the instrument;

FIG. 5 shows a detailed top view of a unformed clip loaded in the jawsof the instrument;

FIG. 6 shows a detailed top view of a clip being formed in the jaws ofthe instrument;

FIG. 7 shows an enlarged top view of the jaw blade assembly of theinstrument;

FIG. 8 shows an enlarged perspective view of the clip cover of theinstrument;

FIG. 9 shows an enlarged perspective view of the jaw blade assembly andclip retainer of the instrument;

FIG. 10 shows an enlarged perspective view of the pusher bar of theinstrument;

FIG. 11 shows an enlarged perspective view of the feed bar of theinstrument;

FIG. 12 shows a side view of the distal end of the instrumentillustrating an unformed clip positioned in the jaws of the instrument;

FIG. 13 shows a side view of the distal end of the instrumentillustrating the position of the clip retainer and feed bar after theclip has been formed in the jaws;

FIG. 14 shows an enlarged perspective view of a clip for use with theinstrument;

FIG. 15 shows an enlarged top view of the clip of FIG. 14;

FIG. 16 is a perspective view of another embodiment of the instrument;

FIG. 17 is an exploded perspective view of the instrument of FIG. 16;

FIG. 18 is an enlarged perspective view of the jaw blade assembly ofFIG. 17;

FIG. 19 is an enlarged perspective view of the clip cover assembly ofFIG. 17;

FIG. 19a is a perspective view of the indicator for showing the numberof clips remaining in the clip series;

FIG. 19b is a side cross-section of the indicator in position in theclip cover of FIG. 19;

FIG. 20 is an enlarged bottom view of the clip cover assembly of FIG.19;

FIG. 21 is an enlarged perspective view of the wedge of FIG. 17;

FIG. 22 is an enlarged perspective view of the knob of FIG. 17;

FIG. 22a is an enlarged, exploded perspective of the keyway connectionbetween the knob of FIG. 22 and the channel assembly 126 and jawassembly 114 of FIG. 17;

FIG. 23 is an enlarged, partial top view of the distal end of the jawblade assembly of FIG. 18;

FIG. 24 shows a detailed top view of an unformed clip loaded in the jawsof the instrument of FIG. 17;

FIG. 25 shows a detailed top view of a clip loaded and formed in thejaws of the instrument of FIG. 17;

FIG. 26 illustrates a perspective view of another embodiment of theinstrument particularly useful for endoscopic procedures;

FIG. 27 illustrates an exploded perspective view of the instrument ofFIG. 26;

FIG. 28 illustrates a perspective view of the instrument during anendoscopic surgical procedure in which the instrument is placed throughthe body wall through the provision of a trocar cannula;

FIG. 29 illustrates a top plan view in partial cross-sectionillustrating the operating mechanism of the instrument prior to crimpinga clip positioned in the jaw assembly; and

FIG. 30 is a view similar to FIG. 29 illustrating the operatingmechanism of the instrument as a clip is being crimped in the jawassembly and applied to the vessel.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

Referring now to drawings, in which like reference numerals identifysimilar or identical elements throughout the several views, andreferring in particular to FIGS. 1 and 2, the surgical clip applier 10of the present invention includes a bottom housing 12, a top housing 14,a jaw blade assembly 17 having a pair of jaws, a channel assembly 16slidably mounted with respect to housings 12, 14, a clip cover 50 and afeed bar 18 slidably mounted in the channel assembly 16. A pair ofhandles 22 are provided for actuating the clip applier and are pivotablysecured to housings 12 and 14 as described below.

Bottom and top housings 12, 14 are secured together by pivot pin 24 andscrews 34. The housings 12, 14 are of slender construction and are madeof any suitable material, for example, plastic material. As seen in FIG.2, the inner surface 13 of the bottom housing 12 is contoured andrecessed so as to receive various components of the applier as furtherexplained below. The inner surface 15 of top housing 14 is contoured forsimilar purposes. The pivot pin 24 extends through the proximal end ofthe housings 12, 14 and the proximal end of handles 22, as best seen inFIG. 3, to pivotally connect the handles 22 between the inner surfacesof the housings 12, 14 which are spaced apart to form a recess forreceiving the handles 22. Spacers 11 are positioned in the housings 12,14 to help maintain the recess between the housings 12, 14.

As shown in FIG. 1, the handles 22 are actuable at their distal ends 23,i.e. the end closest to the surgical site. This provides increasedvisibility, tactility and stability and enables the handles 22 to beheld in a tweezer or pincer-like manner.

Turning now to the jaw blade assembly 17 for forming the clip and withreference to FIGS. 2, 7 and 9, jaw blade assembly 17 includes anelongated jaw blade 36 which has a pair of jaws 38 formed at abifurcated distal end for receiving a surgical clip therein. Each jaw 38is provided with a small slot or groove in a side wall so as to receivetherein a leg of the substantially C-shaped surgical clip 42 shown inFIGS. 14 and 15. Each jaw 38 also includes raised portions 39 which actas a stop for the clip cover 50 mounted thereon. The jaw blade 36 has apair of camming surfaces 41 for engagement by channel assembly 16 toclose the jaw in a manner described below.

The jaw blade assembly 17 also includes along its elongated portion aclip carrier portion 40 upon which a series of clips 42 are positioned.In this embodiment the clip carrier portion 40 is integral with the jawblade assembly 17, although multiple elements could be used to achievethe same result.

The proximal, or rear, end of the jaw blade assembly 17 includes a plate44 having a pair of oppositely positioned openings 46 for receiving thescrews 34 which retain the jaw blade assembly 17 within the housings 12,14. A tail 48 is formed in the proximal-most end of the jaw bladeassembly 17 for providing additional support for the pusher bar 90.

A clip retainer 51 is mounted under the distal end of jaw blade assembly17. With reference to FIGS. 9, 12 and 13, the distal end of the clipretainer 51 has a pair of oppositely positioned side walls 52 and 54 anda raised distal end wall 56. The clip retainer 51 prevents movement inthe distal direction of the stack of clips 42 and is movable from aposition preventing movement of stack of clips 42, as shown in FIG. 12,to a position in which the stack of clips 42 are able to advancedistally, as shown in FIG. 13.

As shown in FIGS. 2 and 11-13, the feed bar 18 is elongated and has adepending nose 84 at its distal end. Nose 84 moves clip retainer 51 intothe position shown in FIG. 13 by engagement of the walls 52 and 54 whenthe feed bar 18 has moved behind a second clip 43 in the series of clips42, but the first clip 42' is still in the jaws 38 of the jaw assembly.

As indicated, the distal end of the feed bar 18 is angled slightlydownwardly with the tip bent up. Feed bar 18 functions to feed thedistalmost clip in the series of clips to the jaws and is slidablypositioned within channel 64 between rails 66 (see FIG. 8) of the clipcover 50. Feed bar 18 further includes a pair of triangular projections86 having cam surfaces 87 which cam the feed bar 18 in the proximaldirection when the handles 22 are closed, and a proximal abutment 88 forreceiving spring 32 as mentioned below.

Clip cover 50, shown in FIGS. 2 and 8, is elongated and similar in shapeto the jaw blade assembly 17 and includes a tissue stop 70. The tissuestop 70 extends distally over the jaw blade 36. This tissue stop 70 hasa bifurcated distal end which overlies and serves as a guide to preventtissue from impeding movement of the clip 42' into the jaws 38. Thetissue stop 70 has a rounded cut out 53, a slot 60 and a pair of roundedends 62 at its distal end. Slot 60 is provided for enabling nose 84 offeed bar 18 to access the series of clips 42 to feed clips to the jaws38. The pair of side walls or rails 66 provide a guide channel 64 forthe feed bar 18. The bottom surface 69 of the clip cover 50 ispositioned atop jaw blade assembly 17 and includes a pair of downwardlyextending side walls or rails 67 between which the series of clips 42and the pusher bar 90 (see FIGS. 2 and 10) are provided.

Referring again to FIGS. 1 and 2, the channel assembly 16, which asmentioned above functions to cam jaws 38 closed, defines an elongatedchannel shaped member for enveloping the jaw blade assembly 17 andincludes a pair of upstanding walls 72, a top wall 74 and a bottom wall76. The top wall 74 and bottom wall 76 include a cutout 78 at theirdistal ends, and at the proximal end top wall 74 includes recess 80which is formed between projections 82. The projections 82 form a femaledovetail connector which engages a male dovetail connector 83 of theforming cam 30 and thereby causes movement of the channel assembly 16upon movement of the forming cam 30, as will be described below.

With reference to FIGS. 2 and 10, elongated pusher bar 90 has oppositelypositioned projections 92 and a rounded member 94 extending from itsdistal end corresponding in shape to the bridge portion of the clips,for engaging and pushing the last and most proximal clip 42" (see FIG.4) in the series of clips 42 on the clip carrier portion 40. Theprojections 92 engage the grooves 208 and the rounded member 94 engagesthe bridge portion 206 of the last clip 42". The proximal end of thepusher bar 90 includes a slot 96 for receiving a spring guide block 98.A coil spring 302 fits within the molded contours of bottom housing 12,and a channel 308 of spring 302 is engaged by the pin 310 which extendsthrough an aperture 311 in the bottom housing 12 to hold the end ofspring 302 in place as coiled portion 304 rolls in the distal direction,urging guide block 98 against pusher bar 90. This gently urges theseries of clips 42 in the distal direction to continue the feeding,loading and clipping process. The feed spring 302 rolls along the top ofits elongated portion 306 as the pusher bar 90 advances the clips 42.

As shown in FIGS. 14 and 15, a surgical clip designed for application bythe clip applier 10 is formed of a unitary piece of biologicallyacceptable, plastically deformable material such as a noble metal (i.e.gold, silver, platinum, titanium etc.). While metal clips are presentlypreferred, it is contemplated that the other materials such as suitablepolymer plastics may be used. The material, preferably titanium, issufficiently ductile or plastically deformable so that when the clipsare crimped there is minimal spring-back. The clip is designed to applycontact force to the tissue regardless of tissue thickness withoutpenetration.

The clip 42 includes a pair of inwardly curved arms 202 and 204interconnected by a bridge portion 206, the two arms extending generallyperpendicular to the bridge portion 206. The arms terminate at tips 210and 212 which are rounded to prevent injury to the subject tissue. Asdescribed above, the bridge portion 206 includes a pair of grooves 208for engagement by the pusher bar 90 of the clip applier 10 describedabove and for advancing the clips down the clip carrier 40 in theapplier. The clip is sized according to the particular end use, but isgenerally of a size suitable for microsurgical applications, in bothnon-endoscopic and endoscopic procedures.

Turning now to the operation of the instrument, and referring to FIGS.1, 2 and 3, each handle 22 is articulated to the housings 12 and 14, andis operable to effect movement of the channel assembly 16, the feed bar18, and ultimately the series of clips 42 and the pusher bar 90 in thefollowing manner. Handles 22 are pivotally connected to the housings 12,14, by pivot pin 24 and extend from the housing on opposite sides asshown. The distal ends of handles 22 are secured by pins 26 which ridealong cam slots 28 of forming cam 30. The forming cam 30 is connected atits distal end through the dovetail connection 82, 83 to the channelassembly 16, as is discussed in detail above, and near its proximal endpost 29 is connected to a spring 32. The other end of the spring isattached to the proximal end of the feed bar 18 at abutment 88 andbiases feed bar 18 in a distal direction. Thus, the spring 32 biases thechannel assembly 16 and the forming cam 30 in a proximal direction, suchthat the handles 22 are biased to an open position, while at the sametime biasing feed bar 18 in a distal direction.

Since each handle is connected in a similar fashion, only the connectionof one of the handles will be discussed. As indicated in FIGS. 2 and 3,the channel assembly 16 is mounted at the distal end of forming cam 30at dovetail connection 82, 83 while the feed bar 18 is attached atabutment 88 through spring 32 to the post 29 at proximal end of formingcam 30. Thus, referring to FIG. 3, when handles 22 close together, thepins 26 move along slots 28 of forming cam 30 to distally advance theforming cam 30 which correspondingly advances the channel assembly 16against the biasing of spring 32. As seen in phantom in FIG. 3, feed bar18 underlies forming cam 30 and is positioned such that cam surfaces 87abut pins 26 as shown. As handles 22 are closed, pins 26 also ride overcam surfaces 87, thus moving feed bar 18 in a proximal direction andfurther extending spring 32, which is concurrently being pulled in thedistal direction by forming cam 30. After the channel assembly 16advances a slight distance distally, e.g. approximately 0.020 inch, thenose 84 of the feed bar 18 moves proximally to a position behind thenext clip 43 in the clip carrier 40, as seen in FIG. 13.

In use, the clip applier 10 is provided with a clip 42' already in thejaws 38 of the jaw blade assembly 17, and feed bar 18 is in the positionshown in FIGS. 4 and 5 to hold clip 42 in place as it is fit over avessel. To apply the clip, the handles 22 are first squeezed togetherovercoming the bias of spring 32 and causing the channel assembly 16 andforming cam 30 to move forwardly (or distally), while at the same time,the feed bar 18 moves rearwardly (or proximally) as pins 26 engage camsurfaces 87, into a position to feed the second clip 43 from the seriesof clips 42 on clip carrier 40 as described above. As the channelassembly 16 moves forwardly and over jaws 38 of the jaw blade assembly17, the jaws 38 are cammed closed to form the clip 42' therein, as seenin FIG. 6. As the jaws 38 close and feed bar 18 moves proximally, thenose 84 of the feed bar 18 moves behind the second clip 43, as seen inFIG. 6, and the first clip 42' is fully formed in the jaws 38. The clipretainer 51, as seen in FIGS. 12 and 13, then is biased downwardly byengagement with the nose 84 of feed bar 18.

As the handles are released, handles 22 automatically open under theinfluence of spring 32, which pulls forming cam 30 proximally and pushesfeed bar 18 distally causing pins 26 to ride in slots 28 to open handles22. The clip retainer 51 continues to be biased downwardly, and the feedcam 18 moves forward and advances the next clip 43 to the jaws 36, dueto pins 26 riding over cam surfaces 87 as spring 32 biases feed bar 18in the distal direction. Furthermore, as pins 26 ride in slots 28 offorming cam 30, cam 30 moves proximally under the influence of spring32, drawing channel assembly 16 with it. The downward biasing of theclip retainer 51 also permits the stack of clips 42, which are normallybiased in a forward direction by spring 302, to advance forward and movedistally, to position the next distalmost clip in position for loadingafter the crimping of clip 43.

Referring now to FIG. 16, the surgical clip applier 100 of analternative embodiment of the present applier includes a bottom housing102, a top housing 104, a jaw blade assembly 114 having a pair of jaws118, and a channel assembly 126 slidably mounted with respect tohousings 102, 104. A pair of handles are provided for actuating the clipapplier and are pivotably secured to housings 102 and 104.

The bottom and top housings 102, 104 are press fit and held together bythe engagement of pin 109 with the pin receiver 119 and by theengagement of pins 121 with holes 129, but alternatively may be weldedor joined by other suitable means. The housings 102, 104 are of slenderconstruction are made of any suitable material, for example, plasticmaterial. As indicated, the inner surface 106 of the bottom housing 102is contoured and recessed so as to receive various components of theapplier as further explained below. The inner surface 106 of top housing104 is contoured for similar purposes. The pivot pin 109 extends fromthe proximal end of the housing 104 to pivotally connect the handles101, 103 between the inner surfaces of the housings 102, 104, which arespaced apart to form a recess for receiving the handles 101, 103. Thehousing 104 also includes a window 111 through which the knob 138extends as seen in FIG. 16.

The handles 101, 103 are actuable at their distal ends 105, i.e. the endclosest to the surgical site. This provides increased visibility,tactility and stability and enables the handles 101, 103 to be held in atweezer or pincer-like manner. The handles 101, 103 are biased outwardlyby a spring 107 which fits in slots 107a of each handle member and isretained by the spring post 131 formed on the inner surface 106 of thebottom housing 102.

Turning now to the jaw blade assembly 114 for forming the clip 42 andwith reference to FIGS. 17, 18, and 23 jaw blade assembly 114 includesan elongated jaw blade 116 which has a pair of jaws 118 formed at abifurcated distal end for receiving a surgical clip therein. Each jaw118 receives a leg of the substantially C-shaped surgical clip 42 fromthe series of clips 158. Each jaw 118 also includes raised portions 120which act in a manner similar to raised portions 39 as described above,as a stop for the clip 42 to enhance formation thereof. The raisedportions 120 include an arcuate portion 135 which conforms in shape tothe leg of the clip 42, as seen in FIGS. 24 and 25. Arcuate portion 135arrests forward or distal movement of the distalmost clip 42 as seriesof clips 158 is urged distally by spring 148. The jaw blade 116 has apair of camming surfaces 124 which are engaged by channel assembly 126to close the jaw 118 in a manner described below. The jaws 118 are bentat an angle of approximately 30 degrees to enhance visibility of thestructure to which the clip 42 is being applied. Another feature of thejaws 118 is that they are flexible and deformable and preferably formedof stainless steel.

The jaw blade assembly 114 also includes along its elongated portion aclip carrier portion 128 upon which series of clips 158 are positioned.Clips 158 are retained in the side walls 170 of the clip cover 122,shown in FIGS. 19 and 20. In this embodiment the clip carrier portion128 is integral with the jaw blade assembly 114, although multipleelements could be used to achieve the same result. Jaw assembly 114 alsois provided with keyway slot 250 whose purpose will be described below.

Clip cover 122, shown in FIGS. 17, 19 and 20 is elongated and similar inshape to the jaw blade assembly 114 and includes a tissue stop 160. Thetissue stop 160 extends distally over the jaws 118, and has a bifurcateddistal end which overlies and serves as a guide to prevent tissue frommoving the clip 42 proximally and out of raised portions 120. The tissuestop 160 has a rounded cut out 162, and a pair of rounded ends 166 atits distal end. The bottom surface 168 of the clip cover 122 ispositioned atop jaw blade assembly 114 and includes a pair of downwardlyextending side walls or rails 170 between which the series of clips 158are retained and the pusher bar 134 and indicator 136 are provided.Indicator 136 is shown in detail in FIG. 19a and its position withinclip cover 122 is shown in FIG. 19b. The distal end of the clip cover122 includes a pair of downwardly extending key portions 145 whichengage cut outs 147 in the jaw blade assembly 114.

Referring to FIGS. 16 and 17, the channel assembly 126, which asmentioned above functions to cam jaws 118 closed, is U-shaped andincludes a reduced height portion 172 at its proximal end for engagementwith the rotation knob 138 at keyway slot 251a as will be describedbelow. Channel 126 also has at its proximal end a transverse slot 164for engaging a link 144 as will be described below. The channel 126envelops the jaw blade assembly 114 and includes a pair of upstandingwalls 174, 176 and a bottom wall 175. The side walls 174, 176 eachinclude an inturned flange 178, 180, respectively, at its top side,formed therein for engagement around the top surface of clip cover 122.Inturned flanges 178 and 180 serve to lock the assembly together, whichincludes cover 122, series of clips 158, pusher bar 134, indicator 136,jaw assembly 118 and rod 142. The reduced height portion 172 of thechannel assembly 126 includes slot 164, and reduced height portion 172extends through a passageway 184 in the knob 138 and matingly engagescorresponding annular flange 186 formed in the link 144 to permitrotational movement of the entire assembly by knob 138.

Referring to FIG. 22a, there is shown the keyway connection between knob138 within passageway 184 with channel assembly 126 and jaw assembly114. Jaw assembly 114 is provided with a keyway slot 250 which matinglyengages keyway post 185a in a secure manner. Keyway post 185a passesthrough slot 251a in channel assembly 126 so that the channel assemblymay slide in response to movement of the handles. Keyway slot 250 locksjaw assembly 114 against longitudinal movement, but permits rotationalmovement due to knob 138. Channel assembly 126 is permitted to slideover post 185a and through knob 138 to crimp a clip in jaws 118 asdescribed below, due to the provision of slot 251a. As can beappreciated, slot 251a is longer and wider than slot 250, and post 185aas well.

Elongated pusher bar 134 has a plurality of transversely extendinggrooves 135 in its distal end to provide flexibility as it advances upthe approximately 30 degree incline of the jaws 118 to feed the last fewclips to the jaws. Otherwise the pusher bar 134 is similar to pusher bar90 as is shown in FIG. 10 for engaging and pushing the last and mostproximal clip of series 158 on the clip carrier 128. A coil spring 148fits within the molded contours of bottom housing 102 and cooperateswith the spring guide block 146 to bias and advance rod 142, which inturn advances indicator 136 and pusher bar 134 distally, therebyadvancing series of clips 158.

Link 144 is provided and facilitates both rotational movement andlongitudinal movement. Link 144 translates longitudinal actuation of theforming cam 154 into movement of the channel 126. An annular flange 186in the link 144 engages slot 164 in the channel assembly 126 tolongitudinally actuate the channel 126 in response to movement of thehandles. It should be noted that while the flange 186 and slot 164engagement permits movement of the channel assembly 126 along itslongitudinal axis, the slot 164 is also free to rotate about the annularflange 186 in response to rotation of the knob 138, thus rotating theentire assembly. A rod 142 extends, and moves longitudinally through thelink 144, but is not actuated by the link. The proximal end of the rod142 engages the spring guide block 146 to translate the bias or tensionof the spring 148 to the pusher bar 134 by its abutment at its distalend to the clip indicator 136 as shown in FIGS. 19a and 19b, and hencepusher bar 134. Forming cam 154 is secured to link 144 by arms 155,which fit about link 144 and into cutouts 196, as described below.

Referring now to FIGS. 17 and 22, the knob 138 retains the proximal endsof and rotates the entire distal assembly including the jaw bladeassembly 114, the series of clips 158, the clip indicator 136, thepusher bar 134, the channel 126 and the clip cover 122. The knob 138receives a wedge 150 as shown in FIG. 21 which provides a friction fitof the jaw blade assembly 114 and clip cover 122 within the knob 138,thereby enabling their rotation in response to rotation of the knob 138but permitting longitudinal movement of pusher bar 134 and channel 126.

Turning now to the operation of the device 100, each handle 101, 103 isarticulated to the housings 102 and 104 and is operable to effectmovement of the channel assembly 126. Handles 101, 103 are pivotallyconnected to opposite sides of the housings 102, 104 and engage pins 108which ride along cam slots 156 of forming cam 154. The forming cam 154is connected by a pair of arms 155 at its distal end to the cutouts 196of the link 144. As indicated in FIG. 17, the channel assembly 126 ismounted at slot 164 to the distal end of link 144 at flange 186 whilethe proximal end of link 144 is attached at cutouts 196 to the distalend of forming cam 154 at arms 155. Thus, when handles 101, 103 closetogether against the biasing of spring 107, the pins 108 move alongslots 156 of forming cam 154 to distally advance the forming cam 154which correspondingly advances link 144 and the channel assembly 126.Channel assembly 126 engages jaws 118 of jaw assembly 114 at cammingsurfaces 124 to close the jaws.

In use, the clip applier 100 is provided with a clip 42 already in thejaws 118 of the jaw blade assembly 114. To apply the clip 42, thehandles 101, 103 are first squeezed together overcoming the bias ofspring 107 and causing the channel assembly 126 to move distally asdescribed above and over jaws 118 of the jaw blade assembly 114. As bestshown in FIG. 25, this movement over the jaws 118 cams the jaws 118closed causing the raised portions 120 of the jaws 118 to form the clip42 therein. The flexibility of the jaws 118 prevents trauma to tissue inwhich the clip 42 is being applied by not further forming the clip 42 ordamaging tissue once the clip 42 has been formed. This trauma isprevented by the jaw arms 149 which absorb the overstroke and deflectonce the clip 42 has been fully formed and the jaws 118 are closed, butthe channel assembly is still advancing. As the handles 101, 103 open,the formed clip 42 is released from the jaws 118, and the pusher bar 134is advanced distally to advance the next clip 42' to the jaws 118. Theclip is retained in the jaws by the raised portions 120 and arcuateportion 135. The clips are urged forward as a group, and are held frombeing forced back in a proximal direction by each other in conjunctionwith pusher bar 134. The clip indicator 136 may be viewed through thewindow 123 on the clip cover 122 to display approximately how many clipsin series 158 are left in the device 100.

Turning to the embodiment shown in FIG. 26, there is illustrated anendoscopic clip applier for the application of microclips in anendoscopic or laparoscopic surgical procedure. Heretofore, althoughprior art devices have been developed for the application of surgicalclips in endoscopic surgical procedures, it has not been possible tostore multiple clips and individually apply microclips (withoutindividually loading each clip) during such procedures due to the minutesize of the clips and the correspondingly small size of the componentsof the clip applier. The device of FIG. 26 provides such a microclipapplier, particularly suited for endoscopic and laparoscopicmicrosurgical procedures.

Referring to FIGS. 26 and 27, instrument 400 is provided which includesendoscopic body portion 402 for accessing remote surgical sites inendoscopic or laparoscopic surgical procedures. Instrument 400 issubstantially identical to instrument 100 as described above withreference to FIGS. 16-25, except for the elongated portion defined byendoscopic body portion 402 and the elongation of the channel 172 androd 142 disposed therein. As seen in FIG. 27, endoscopic body portion402 includes top tube portion 404 and bottom tube portion 406, whichsubstantially enclose the clip applying mechanism which includes channelassembly 126, jaw assembly 114, series of clips 158, pusher bar 134,indicator 136 and clip cover 122. Bottom tube 406 includes keyway post185b which passes through slot 251b in channel assembly 126, and ismatingly engaged in a secure manner in slot 250 to permit longitudinalmovement of channel assembly 126 while preventing longitudinal movementof jaw assembly 114. This permits channel assembly 126 to move to crimpa clip positioned in jaws 118. As explained with reference to FIG. 22aabove, slot 251b is wider and longer than post 185b and slot 250 in jawassembly 114. With reference to FIGS. 27 and 22a, slot 250a engages post185a in knob 138 to secure the endoscopic body portion 402 to knob 138to facilitate rotation of body portion 402.

A seal device such as O-ring 408 is provided and is positioned withinendoscopic body portion 402 substantially enclosing the assembly formedby clip cover 122, series of clips 158, pusher bar 134, jaw assembly 114and channel assembly 126. O-ring 408 substantially surrounds thesecomponents and is wedged between top tube portion 404 and bottom tubeportion 406 to prevent the leakage of gas through the instrument duringthe endoscopic surgical procedure.

Typically, in an endoscopic surgical procedure, the cavity isinsufflated with gas such as carbon dioxide to inflate the cavity topermit the surgeon to access the surgical objective without interferencefrom adjacent tissue and organs. Accordingly, it is desirable to providesome sort of seal means in the endoscopic portion of the instrumentationto prevent the inadvertent leakage of the insufflation gas through theinstrument itself. O-ring 408 is shown for illustration purposes only,and it is contemplated that any suitable seal mechanism may be providedwithin endoscopic body portion 402.

FIG. 28 illustrates the present instrument in use during an endoscopicsurgical procedure. After the body cavity is insufflated, a trocarassembly is utilized to puncture the body wall 414 to provide access forthe surgical instrumentation to perform the endoscopic or laparoscopicsurgical procedure. After the trocar assembly is put in place, theinstrument is inserted through trocar housing 410 and trocar cannula 412and exits the trocar assembly adjacent the surgical site. In theillustration shown in FIG. 28, a pair of severed vessels, typically ablood vessel, are to be rejoined. The vessels are placed adjacent eachother and their ends everted by the surgeon using instrumentation suitedfor this purpose. Once the everted ends 420 are placed adjacent eachother, the instrument is utilized to apply clips 42 about thecircumference of the everted vessels to join them together. The surgeonwill apply as many clips as necessary to rejoin the severed vessels 416and 418.

FIGS. 29 and 30 illustrate the present invention in operation. FIG. 29illustrates the instrument in the at rest condition where the jawassembly 114 is positioned adjacent a pair of vessels 416 and 418 to bejoined. The everted ends 420 are placed side by side and the jawassembly positioned over the everted ends to apply the microclip. Asseen in FIG. 29, handles 101, 103 are in their at rest condition wherepins 108 are at the distalmost position in slots 156 of forming cam 154.The distal end of forming cam 154, namely arms 155, engage the cutouts196 and link 144, which is further connected as described above tochannel assembly 126 at slot 164. Rod 142 passes through link 144beneath forming cam 154 and engages guide block 146 at its proximal endand indicator 136 at its distal end to urge the series of clip 158 in adistal direction.

In order to crimp a clip 42 positioned in the jaws 118, handles 101, 103are closed in the direction of arrow "A" as indicated in FIG. 30. As thehandles are closed, pins 108 ride in cam slots 156 of forming cam 154 tomove forming cam 154 in the distal direction. As this occurs, link 144is moved in a distal direction which consequently moves channel assembly126 in the distal direction as indicated by arrow "B". As channelassembly 126 moves in the distal direction, the distal end of channelassembly 126 engages camming surfaces 124 of jaws 118 to cam the jawsclosed and crimp the clip 42 positioned therebetween. When handles 101,103 are released, spring 107 (as shown in FIG. 27) returns theinstrument to the position shown in FIG. 29.

Other variations and modifications of the applier may occur to those ofskill in the art. It is therefore intended that the foregoing beregarded as merely illustrative, which should be measured by the claimsthat follow.

What is claimed is:
 1. A surgical clip applicator comprising:a housing;an endoscopic body portion extending distally from the housing; a pairof handles pivotally connected to the housing, each of the handleshaving a proximal end and a distal end and being pivotally mounted tothe housing at their proximal ends, the handles being actuable in atweezer-like manner; a pair of jaws extending from the endoscopic bodyportion, the jaws being configured to receive a clip from a series ofclips and being movable between an open position and a closed positionto deform a clip positioned therebetween; a pusher bar engaging aproximalmost clip to urge the series of clips towards the pair of jaws;and an actuating mechanism operably connected to the handles, theactuating mechanism being movable to move the jaws between the open andclosed positions.
 2. A surgical clip applicator as defined in claim 1,further comprising a biasing member positioned to urge the pusher barand the series of clips towards the jaws to position the distal-mostclip of the series of clips between the pair of jaws when the jaws arein the open position.
 3. A surgical clip applicator as defined in claim1, further comprising a channel assembly slidably positioned within thehousing and being movable into engagement with the jaws to move the jawsfrom the open position to the closed position.
 4. A surgical clipapplicator as defined in claim 3, wherein the actuating mechanismincludes a forming cam operatively connected between the channelassembly and the pair of handles, the forming cam being configured tomove the channel assembly distally in response to inward pivoting of thehandles.
 5. A surgical clip applicator as defined in claim 4, whereinthe forming cam includes at least one cam slot and is slidablypositioned in the housing, the pair of handles having at least one pinpositioned within the cam slot.
 6. A surgical clip applicator as definedin claim 4, wherein the forming cam includes a pair of cam slots andeach of the handles includes a pin positioned within a respective one ofthe cam slots.
 7. A surgical clip applicator as defined in claim 3,further comprising a rotatable member rotatably connected to the housingand having a throughbore configured to support the endoscopic bodyportion, the channel assembly, the pair of jaws, and the pusher bar tofacilitate rotation thereof, wherein the channel assembly and the pusherbar extend through the endoscopic body portion.
 8. A surgical clipapplicator as defined in claim 7, wherein the actuating mechanismincludes a non-rotatable link operatively connected to the channelassembly to permit rotation of the channel assembly, the link beingslidable longitudinally to permit longitudinal movement of the channelassembly.
 9. An endoscopic surgical clip applicator comprising:a housingand an elongated body portion extending from the housing; a pair ofhandles pivotally connected to the housing; a pair of jaws having a clipreceiving portion positioned distally of the elongated body portion, thejaws being relatively movable from an open position to a closedposition; a series of microclips arranged in end-to-end relation in arow in the elongated body portion, wherein in the open position, thejaws are configured to receive a microclip from the series of microclipsand in the closed position, the jaws deform the microclip positionedtherebetween; a pusher bar mounted for movement only in the distaldirection to urge the series of microclips towards the jaws; and abiasing member cooperating with the pusher bar, the biasing member beingpositioned to urge the pusher bar and the series of microclips towardsthe jaws to position a distal-most microclip from the series ofmicroclips between the jaws when the jaws are in the open position. 10.A surgical clip applicator as defined in claim 9, further comprising achannel assembly positioned within the housing and being movable intoengagement with the jaws to move the jaws from the open position to theclosed position.
 11. A surgical clip applicator as defined in claim 10,further comprising a rotatable member having a throughbore supported onthe housing, the channel assembly, the pair of jaws, and the pusher barbeing secured within the throughbore to facilitate rotation thereof. 12.A surgical clip applicator as defined in claim 9, further comprising anendoscopic body portion extending distally from the housing, wherein theseries of microclips, the pusher bar, and the biasing member areenclosed within the endoscopic body portion.
 13. An apparatus forendoscopically applying surgical clips in vascular surgical procedurescomprising:a handle portion; an elongated body portion extending fromsaid handle portion and defining a longitudinal axis; a jaw mechanismextending from said body portion at an end opposite said handle portionand movable between an open position for receiving a clip and a closedposition for forming a clip, said jaw mechanism being disposed at anangle with respect to longitudinal axis of said body portion; aplurality of clips disposed within said body portion; means foradvancing said plurality of clips to urge a clip into said jawmechanism, said advancing means comprising a pusher bar member and abiasing member, the biasing member being positioned to continuously urgethe pusher bar and the series of clips towards the jaw mechanism toposition and maintain a distal-most clip from the series of clips in thejaw mechanism as the jaw mechanism is moved between the open positionand the closed position; and retaining means disposed on said jawmechanism for holding a clip in said jaw mechanism; wherein saidretaining means, said advancing means and said angle of said jawmechanism cooperate to urge a clip into said jaw mechanism and toprevent said clip from being advanced distally through said jawmechanism.
 14. An apparatus according to claim 13, wherein, said pusherbar member includes means at a distal end for permitting flexing of saidpusher bar member when disposed in said angle of said jaw mechanism. 15.An apparatus according to claim 14, wherein said means for flexing saidpusher bar member includes at least one transverse groove adjacent saiddistal end.
 16. An apparatus according to claim 13, further comprising arotation knob mechanism for rotating said body portion and said jawmechanism with respect to said handle portion.
 17. An apparatusaccording to claim 13, wherein said body portion includes a seal meansfor preventing leakage of gas and fluids through said body portion. 18.An apparatus according to claim 13, wherein said retaining meanscomprises a portion of said jaw mechanism having a shape complementaryto a shape of said clip for receiving and retaining said clip.
 19. Anapparatus according to claim 18, wherein said portion of said jawmechanism comprising said retaining means defines an arcuate shape alongsaid longitudinal axis, said clips being C-shaped and defining legportions complementary in shape to said arcuate retaining means.
 20. Anapparatus for endoscopically applying surgical clips in vascularsurgical procedures comprising:a handle portion; an elongated bodyportion extending from said handle portion; a pair of jaw membersextending from said body portion at an end opposite said handle portionand movable between an open position for receiving a clip and a closedposition for forming a clip, said open position defining a gap betweensaid jaw members; a plurality of clips disposed within said bodyportion; a pusher bar member movable only in the distal direction toadvance said plurality of clips to urge a clip into said jaw members;and a camming mechanism associated with said body portion for cammingsaid jaw members from said open position to said closed position; andsaid pusher bar member urging said plurality of clips such that eachclip in said plurality of clips is contacted by at least one other clip,and said clips cooperate to urge a distalmost one of said clips betweensaid jaw members and to maintain said distalmost clip between said jawmembers while said jaw members are moved from said open position to saidclosed position.
 21. An apparatus according to claim 20, wherein saidbody portion includes a channel assembly which is slidable with respectto said handle portion and said jaw members to move said jaw members tosaid closed position to form a clip positioned therebetween.
 22. Anapparatus according to claim 21, further comprising a rotation knob forrotating said body portion and said jaw members with respect to saidhandle portion.
 23. An apparatus according to claim 22, wherein saidcamming mechanism includes a link member joining said handle portion tosaid body portion, said link member permitting rotational movement ofsaid body portion and longitudinal movement of said channel assemblywithin said body portion.
 24. An apparatus according to claim 21,wherein said camming mechanism joins said channel assembly to saidhandle portion.
 25. An apparatus according to claim 20, wherein saidhandle portion includes a pair of handle members pivotably connected tosaid handle portion at a proximal end thereof, said handle members eachincluding a gripping portion at a distal end thereof, said grippingportions being disposed adjacent said body portion.
 26. An apparatusaccording to claim 20, wherein said jaw members are angled with respectto a longitudinal axis of said body portion.
 27. An apparatus accordingto claim 20, wherein said pusher bar member is spring biased.
 28. Anapparatus according to claim 20, wherein said jaw members include aretaining means complementary in shape to said clips for retaining saidclips in said jaw members prior to forming.
 29. A method for performinganastomosis procedures in endoscopic vascular surgery, comprising thesteps of:a) incising a patient's skin to provide access for at least avascular clip applying instrument; b) providing a vascular clip applyinginstrument; c) inserting said vascular clip applying instrument intosaid patient; d) everting respective ends of first and second vesselportions; e) positioning the evened ends in contacting adjacent relationwith respect to each other; f) positioning said clip applying instrumentadjacent the everted ends, the instrument including an endoscopicportion and a jaw assembly having a pair of jaws extending from theendoscopic portion, and a series of vascular clips supported in theendoscopic portion, the instrument further including a handle assemblyhaving a pair of handle members, the handle members being pivotable in atweezer like manner to close the jaws to crimp a vascular clippositioned therebetween; g) positioning the pair of jaws of theinstrument over a first portion of the everted end of the vesselportions; h) closing the handle assembly of the instrument in a tweezerlike manner to close the pair of jaws and crimp a vascular clippositioned therebetween about the first portion of the everted ends; i)opening the handle assembly of the instrument to release the crimpedvascular clip and to allow the foremost clip of the series of clips tobe fed between the jaws; j) repositioning the pair of jaws over anotherportion of the everted ends of the vessel portions and applying theforemost vascular clip to such portion of the everted ends of the vesselportions; and k) repeating step i)-j) to apply a plurality of clips toother portions of the everted ends of the vessel portions to anastomosethe vessels.
 30. The method according to claim 29, further comprisingthe steps of inserting a cannula sleeve into each of said incisions, andinserting said instruments through said cannula sleeves into saidpatient.
 31. The method according to claim 29, further comprising thesteps of removing said instruments following anastomosis of the vessels,and closing said incisions in the patient.
 32. A surgical clipapplicator comprising:a housing and an elongated body portion extendingfrom the housing; a handle assembly pivotally connected to the housing;a jaw assembly having a clip receiving portion positioned distally ofthe elongated body portion, the jaw assembly being relatively movablefrom an open position to a closed position; a series of clips arrangedin end-to-end relation, wherein in the open position, the jaw assemblyis configured to receive a clip from the series of clips and in theclosed position, the jaw assembly deforms the clip positionedtherebetween; a pusher bar movable toward the jaw assembly to urge theseries of clips towards the jaw assembly; and a spring biasing membercooperating with the pusher bar, the biasing member being positioned tourge the pusher bar and the series of clips towards the jaw assembly toposition a distal-most clip from the series of clips within the jawassembly when the jaw assembly is open and to maintain the distal-mostclip in position within the jaw assembly at least until the distal-mostclip has been partially deformed.
 33. A surgical clip applicator asdefined in claim 32, further including a jaw blade extending from thedistal end of the housing, the jaw assembly being positioned at thedistal end of the jaw blade.
 34. A surgical clip applicator as definedin claim 33, wherein the series of clips is supported on the jaw blade.35. A surgical clip applicator as defined in claim 32, wherein the clipsare serially arranged such that each clip in the series of clips ispositioned to continuously engage adjacent clips.
 36. A surgical clipapplicator as defined in claim 32, wherein the handle assembly comprisesa pair of handles, each of the handles having a proximal end and adistal end, the proximal end of the handles being pivotably mounted tothe housing such that the handles are actuable in a tweezer-like manner.37. A surgical clip applicator as defined in claim 32, furthercomprising a channel assembly slidably mounted with respect to thehousing and the jaw assembly and adapted for slidable movement intoengagement with the jaw assembly to move the jaw assembly from the openposition to the closed position to deform a clip positionedtherebetween.
 38. A surgical clip applicator as defined in claim 37,further comprising a forming cam operatively connected between thechannel assembly and the handle assembly such that when the handleassembly is pivoted toward the housing, the forming cam is moveddistally to move the channel assembly distally.
 39. A surgical clipapplicator as defined in claim 38, wherein the forming cam includes atleast one cam slot which interacts with a pin connected to the handleassembly to move the channel assembly distally.
 40. A surgical clipapplicator as defined in claim 38, further comprising a springpositioned to bias the handle assembly outwardly to move the channelassembly and the forming cam in a proximal direction.
 41. A surgicalclip applicator as defined in claim 37, further comprising a windowformed in the housing and a rotatable member having a throughborepositioned in the window, the channel assembly, jaw assembly, and pusherbar being secured within the throughbore to facilitate rotation thereof.42. A surgical clip applicator as defined in claim 32, wherein thebiasing member is positioned within the housing, and wherein theapplicator further comprises a rod extending between the biasing memberand the pusher bar to urge the pusher bar distally.
 43. A surgical clipapplicator as defined in claim 32, wherein the pusher bar is positionedproximal of and engages the proximal-most clip from the series of clipsand remains engaged with the proximalmost clip as it urges thedistal-most clip into position between the jaws.
 44. An apparatus forendoscopically applying surgical clips in vascular surgical procedurescomprising:a handle portion; an elongated body portion extending fromsaid handle portion and defining a longitudinal axis; a jaw mechanismextending from said body portion at an end opposite said handle portionand movable between an open position for receiving a clip and a closedposition for forming a clip in response to movement of said handleportion, said jaw mechanism being disposed at an angle with respect tolongitudinal axis of said body portion; a plurality of clips disposedwithin said body portion; means for advancing said plurality of clips tourge a clip into said jaw mechanism, said advancing means comprising apusher bar member and a biasing member, the biasing member beingpositioned to urge the pusher bar and the series of clips towards thejaw mechanism to position and maintain a distal-most clip from theseries of clips in the jaw mechanism as the jaw mechanism is movedbetween the open position and the closed position; and retaining meansdisposed on said jaw mechanism for holding a clip in said jaw mechanism;wherein said retaining means, said advancing means and said angle ofsaid jaw mechanism cooperate to urge a clip into said jaw mechanism andto prevent said clip from being advanced distally through said jawmechanism; and wherein said body portion includes a channel assemblywhich is slidable with respect to said handle portion and said jawmembers to move said jaw members to said closed position to form a clippositioned therebetween.
 45. An apparatus for endoscopically applyingsurgical clips in vascular surgical procedures comprising:a handleportion; an elongated body portion extending from said handle portionand defining a longitudinal axis; a jaw mechanism extending from saidbody portion at an end opposite said handle portion and movable betweenan open position for receiving a clip and a closed position for forminga clip in response to movement of said handle portion, said jawmechanism being disposed at an angle with respect to longitudinal axisof said body portion; a plurality of clips disposed within said bodyportion; means for advancing said plurality of clips to urge a clip intosaid jaw mechanism, said advancing means comprising a pusher bar memberand a biasing member, the biasing member being positioned to urge thepusher bar and the series of clips towards the jaw mechanism to positionand maintain a distal-most clip from the series of clips in the jawmechanism as the jaw mechanism is moved between the open position andthe closed position; and retaining means disposed on said jaw mechanismfor holding a clip in said jaw mechanism; wherein said retaining means,said advancing means and said angle of said jaw mechanism cooperate tourge a clip into said jaw mechanism and to prevent said clip from beingadvanced distally through said jaw mechanism; and wherein said handleportion includes a pair of handle members pivotably connected to saidhandle portion at a proximal end thereof, said handle members eachincluding a gripping portion at a distal end thereof, said grippingportions being disposed adjacent said body portion.
 46. A surgical clipapplicator comprising:a housing; a handle assembly pivotally connectedto the housing; a jaw assembly extending from a distal end of thehousing, the jaw assembly being relatively movable from an open positionto a closed position; a series of clips arranged in end-to-end relation,wherein in the open position, the jaw assembly is configured to receivea clip from the series of clips and in the closed position, the jawassembly deforms the clip positioned therebetween; a pusher bar movabletoward the jaw assembly to urge the series of clips towards the jawassembly; and a biasing member cooperating with the pusher bar, thebiasing member being positioned to urge the pusher bar and the series ofclips towards the jaw assembly to position a distal-most clip from theseries of clips within the jaw assembly when the jaw assembly is openand to maintain the distal-most clip in position within the jaw assemblyat least until the distal-most clip has been partially deformed; and achannel assembly slidably mounted with respect to the housing and thejaw assembly and adapted for slidable movement into engagement with thejaw assembly to move the jaw assembly from the open position to theclosed position to deform a clip positioned therebetween.
 47. A surgicalclip applicator as defined in claim 46, wherein the handle assemblyincludes a pair of handles, each of the handles having a proximal endand a distal end, the proximal end of the handles being pivotablymounted to the housing such that the handles are actuable in atweezer-like manner.
 48. A surgical clip applicator as defined in claim46, further comprising a rotatable member supported on the housing, thejaw assembly being operably connected to the rotatable member tofacilitate rotation of the jaw assembly.
 49. A surgical clip applicatoras defined in claim 46, wherein the pusher bar is positioned proximal ofand engages the proximal-most clip from the series of clips and remainsin this position as it urges the distal-most clip from the series ofclips between the jaws.